Confidential Financial Disclosure Form - OGE Form 450

1 INSTRUCTIONS FOROGE FORM 450, Confidential FINANCIALDISCLOSURE REPORT A. Why You Must FileThis report is a safeguard for you as well as theGovernment. It provides a mechanism for determiningactual or potential conflicts between your publicresponsibilities and your private interests andactivities. This allows you and your agency to fashionappropriate protections against such conflicts. B. Who Must FileAgencies are required to designate positions at orbelow GS-15, O-6, or comparable pay rates, in whichthe nature of duties may involve a potential conflictof interest. Examples include contracting,procurement, administering grants and licenses,regulating/auditing non-Federal entities, otheractivities having a substantial economic effect onnon-Federal entities, or law special Government employees (SGEs) must file,unless exempted by their agency or subject to thepublic reporting system.

2 Agencies may also requirecertain employees in positions above GS-15, O-6, ora comparable pay rate to file. C. When To FileNew entrant reports: Due within 30 days of assuminga position designated for filing, unless your agencyrequests the report earlier. No report is required ifyou left another filing position within 30 days prior toassuming the new position. (SGEs must file newreports upon each reappointment or redesignation,at the time specified by the agency.)Annual reports: Due not later than October 31,unless extended by your agency. D. Reporting PeriodsNew entrant reports: The reporting period is thepreceding twelve months from the date of reports: The reporting period coversOctober 1 through September 30 (or that portion notcovered by a new entrant report). However, no reportis required if you performed the duties of your positionfor less than 61 days during that twelve-monthperiod.

3 (All reappointed or redesignated SGE's filereports, regardless of the number of days worked). E. Where To FileWith ethics officials at the agency in which you serveor will serve, or in accordance with their procedures. F. DefinitionsDependent Child - means your son, daughter,stepson, or stepdaughter if such person is either:(1) unmarried, under age 21, and living inyour household; or(2) a dependent of yours for Federalincome tax purposes. See 26 - means payments (direct or indirect) ofmoney or anything of value to you or your spouse foran appearance, speech or article, excluding necessarytravel expenses. Also included are payments tocharities in lieu of Government Employee (SGE) - is defined in18 202(a) as: an officer or employee of anagency who performs temporary duties, with orwithout compensation, for not more than 130 days ina period of 365 days, either on a full-time orintermittent basis.

4 G. General Instructions1. Filers must provide sufficient information aboutoutside interests and activities so that ethics officialscan make an informed judgment as to compliancewith applicable conflict of interest laws and standardsof conduct This form consists of five parts, which requireidentification of certain specific Financial interestsand activities. NO Disclosure OF AMOUNTS ORVALUES IS REQUIRED. You must complete eachpart (except as indicated for Part V) and sign thereport. If you have no information to report in anypart or do not meet the threshold values for reporting,check the None box. New entrants and SGEs arenot required to complete Part You must include information applicable toyourself, your spouse, and dependent children onParts I, II and V. This is required because theirfinancial interests are attributed to you under ethicsrules in determining conflicts of interest.

5 Informationabout your spouse is not required in the case ofdivorce, permanent separation, or temporaryseparation with the intention of terminating themarriage or permanently separating. Parts III and IVrequire disclosures about yourself You may distinguish any entry for a familymember by preceding it with S for spouse, DC fordependent child, or J for jointly I: Assets & IncomeAssets:1. Report all assets held for investment or for theproduction of income by you, your spouse, anddependent children, with a value greater than$1,000 at the end of the reporting period orwhich produced more than $200 in incomeduring the reporting and Earned yourself: report all sources of salary andearned income greater than $200 during thereporting your spouse: report all sources of salaryand earned income if greater than $1,000 (forhonoraria, if greater than $200).

6 Dependent children: no earned incomeneeds to be of Assets: Stocks Bonds Tax Shelters Investment Real Estate Mutual Funds Pensions Annuities IRA/401(k) Holdings Trust Holdings Commodity Futures Trades & Businesses Partnership Interests Investment Life Insurance Collectibles held forInvestmentExamples of Income:Investment IncomeEarned/Other Income Dividends Fees Rents and Royalties Salaries Interest Commissions Capital Gains Retirement Benefits HonorariaNotes:1. For pensions, you will ordinarily just need toindicate the name of the sponsoring , if you have control over the specificinvestment assets held in your pension account(it is not independently managed), you must alsolist those underlying investments or attach anaccount statement that lists For publicly available mutual funds, you areonly required to indicate the name of the fund,not the investments that the mutual fund holdsin its portfolio.

7 You must, however, alwaysindicate the full name of the specific mutualfund in which you hold shares, not just thegeneral family fund For other publicly available investment funds,such as publicly offered units of limitedpartnerships, the Disclosure requirements arethe same as for mutual funds -- list the full nameof the limited partnership, but not its underlyingportfolio For a privately held trade or business, reportits name, location, and description of Not Report:1. Your personal residence, unless you rent it out;2. Federal Government salary or retirement benefitssuch as the Thrift Savings Plan;3. Social Security benefits;4. Money owed to you, your spouse, or dependentchild by a spouse, parent, sibling or child;5. Accounts including certificates of deposit,savings accounts, interest-bearing checkingaccounts, or any other forms of deposit in abank, savings and loan association, credit unionor similar Financial institution;6.

8 Money market mutual funds and money marketaccounts;7. Government obligations (including Treasurybonds, bills, notes and saving bonds);8. Government securities issued by agencies or Government-sponsoredcorporations, such as TVA, GNMA, FNMA; and9. The underlying holdings of a trust that: 1) wasnot created by you, your spouse, or dependentchildren, and 2) the holdings or sources ofincome of which you, your spouse, and dependentchildren have no past or present knowledge. Anexample is a trust created by a relative, fromwhich you receive periodic income but have noknowledge about its assets. Just identify thetrust by name and date of II: LiabilitiesReport for Yourself, Spouse, and Depen-dent Children:1. Liabilities over $10,000 owed to any creditor atany time during the reporting Not Report:1. Mortgages on your personal residence unlessyou rent it out;2.

9 Personal liabilities owed to a spouse, or theparent, sibling, or child of you, your spouse, ordependent child;3. Loans for personal automobiles, householdfurnishings, or appliances, where the loan doesnot exceed the purchase price; and4. Revolving charge accounts where the outstandingliability does not exceed $10,000 at the end ofthe reporting III: Outside PositionsReport for Yourself:1. All positions outside the Government heldat any time during the reporting period (includingpositions no longer held), whether or not include an officer, director, trustee, generalpartner, proprietor, representative, executor,employee, or consultant of any of the following:1. A corporation, company, firm, partnership, trust,or other business enterprise;2. A non-profit organization;3. A labor organization; and4. An educational or other institution outside theFederal Not Report:1.

10 Positions held in any religious, social, fraternal,or political entity;2. Positions solely of an honorary nature; and3. Positions held by a spouse or dependent Not Report:1. Anything received from relatives, the , , State, or local governments;2. Bequests and other forms of inheritance;3. Gifts and travel reimbursements given to youragency in connection with your official travel;4. Gifts of hospitality (food, lodging, entertainment)at the donor s residence or personal premises;and5. Gifts or reimbursements received by a spouse ordependent child totally independent of therelationship to the filer (Example: a spouse'sreimbursement in connection with privateemployment).Privacy Act StatementTitle I of the Ethics in Government Act of 1978 ( App.), Executive Order 12674, and 5 CFR Part2634, Subpart I, of the Office of Government Ethicsregulations require the reporting of this primary use of the information on this form is forreview by Government officials of your agency, todetermine compliance with applicable Federal conflictof interest laws and regulations.